Motivational Interviewing

Department of PsychologyUniversity of Southern Queensland

Motivational InterviewingMotivational Interviewing

adopts a respectsclient-centred the person’s but directive right to style choose

(Miller & Rollnick, 1991; Saunders et al., 1996)

2 key elements

Conceptual LevelConceptual Level Appreciate where the person is now

assess change readiness respond to stage of change accordingly support forward momentum

Conceptualise absence of change at a process level simply a stage in the change process

a behaviour operating now NOT ‘failure’ or ‘non-compliance’ or

‘lack of motivation’

Transtheoretical Model of ChangeTranstheoretical Model of Change based on Prochaska’s search for

common principles in therapy and behaviour change (1979)

compared 18 major theories 9 processes identified

empirical analysis of ‘self-changers’ vs. people in professional treatment (with DiClemente, 1982)

The 9 Common FactorsThe 9 Common Factorsadapted from Prochaska & DiClemente, 1983adapted from Prochaska & DiClemente, 1983

consciousness raising

self-liberation

social liberation

self-re-evaluation

emotional arousal

I look for information related to ….

I tell myself I am able to change if I want to.

I notice social cues supporting the change

My current behaviour causes me distress.

Concern about my current behaviour effects me emotionally

Common factors, cont. environmental control

counter-conditioning

reward

helping relationships

I remove things from my immediate environment which support the problem behaviourI do something else (eg instead of smoking, if I need to relax)I am rewarded by friends/ family for change

I have someone I can talk to about problem behaviour / change

The 6 Stages The 6 Stages of Changeof Change

ActionAction PreparationPreparation

ContemplationContemplationMaintenanceMaintenance

RelapseRelapse

Pre-ContemplationPre-ContemplationPermanent Exit..?Permanent Exit..?

(Prochaska & Di Clemente, 1991)

Stages in the Change Model 1Stages in the Change Model 1

Pre-ContemplationPre-Contemplation not yet ready, willing and/or able

ContemplationContemplation currently weighing pro’s and con’s

PreparationPreparation decision made to change behaviour

Stages in the Change Model 2Stages in the Change Model 2

ActionAction practicing new behaviour 3-6 months

MaintenanceMaintenance continuing commitment to new behaviour

RelapseRelapse resumed old behaviour – “off the wagon” seen as learning spiral towards change

Working With Pre-ContemplationWorking With Pre-Contemplation

validate and clarify OK to be where they’re at choice for change remains theirs

support re-evaluation of behaviour explain the risk in terms that make

sense for the person in their world

Working With ContemplationWorking With Contemplation validate and clarify

OK to be where they’re at choice for change remains theirs

support re-evaluation of pro’s and con’s of behaviour change help to identify and advocate

positive expectations for change

Working With PreparationWorking With Preparation identify obstacles to change

assist in problem solving assist in identifying social support

check skills OK for change assess level of perceived efficacy identify and encourage first steps

towards change

Working With ActionWorking With Action re-frame cues that lead to

problem behaviour check continued social support

reinforce self-efficacy strategies for managing obstacles

to change reflect feelings of loss, grief reinforce long-term benefits

Working With MaintenanceWorking With Maintenance

plan for continued support ensure ongoing links

reinforce internal rewards validate persistence discuss relapse potential, prevention,

and post-relapse reactions

Working With RelapseWorking With Relapse

evaluate triggers re-evaluate motivation for change re-evaluate obstacles

identify new or stronger strategies normalise relapse as part of the change

process

Essence of MIEssence of MI

it’s not up to you to solve the problem your role is to help the person tell you

what they want to do (self motivation) if we push one way, they tend to go

another way as the person argues for one solution,

they become more committed (“I learn what I believe as I hear myself speak”)

Guiding Principles of MIGuiding Principles of MI when people are pushed they rebel when people argue, they consolidate

their own point of view So:

de-emphasise labelling and argumentation highlight difference btw behaviour and belief ambivalence is normal and OK accept the person’s choice

(Miller & Rollnick, 1991)

Elements of the ApproachElements of the Approach

establish rapport

clarify agenda

assess importance and confidence

explore importance build confidence

summarise and identify next steps (Saunders et al., 1996)

Clarify The AgendaClarify The Agenda

During discussion about perceived issues, write

each problem in a different circle -

Feel unfit & unhealthy

Moneyhassles!

Partner’s expectations!

“We can’t deal with all of these at once - which do you feel most ready to do something about ?”

Study deadlines!

Explore ImportanceExplore Importance

On a scale of 1-10, where 10 equals ‘very

important’, how important is it to you to be fit and healthy?

Why have you placed yourself there?

Why so high (low)? What would help you to move higher?

Can you think of anything that would help you move up a step?

Is there anything someone else can do to help you move up a step?

Build ConfidenceBuild Confidence

On a scale of 1-10 (1 = not confident, 10 = very confident), how confident are you that you can become fit and healthy?

Why have you placed yourself there? Why so high (low) ? What would help you to move higher?

Can you think of anything that would help you move up a step?

Is there anything someone else can do to help you move up a step?

More ‘Importance’ Q’sMore ‘Importance’ Q’s

Can you think of some good things about (the situation)?

What are the less good things about (the situation)?

And is there anything else? Where does that leave you now?

More ‘Confidence’ Q’sMore ‘Confidence’ Q’s Is there anything that you’ve already

found helpful? When did you manage better? Even if it was only easier for a short

time, what made it easier? Is there anything you can learn from

things you’ve already tried? Do you know what’s worked for others?

Your task now…Your task now… form dyads (‘client’ and counsellor) think of an aspect of your own behaviour

that you’re ambivalent about eg smoking not exercising procrastinating

assess ‘client’s’change readiness clarify the agenda use importance and and confidence

questions to arrive at a change strategy

Limitations of MILimitations of MI individual focus no attention to structural factors

affecting behaviour no attention to environmental factors

affecting behaviour descriptive rather than causative may not generalise to other populations